文新艳,方舒,杨帆,范芳芳,周佐邑,郑博,龚艳君,霍勇

• 1:北京大学第一医院心内科
• 2:北京大学人民医院心内科

摘要(Abstract)：

目的 探讨经皮冠状动脉介入治疗（PCI）术后即刻基于计算流体力学的造影血流储备分数（post-PCI caFFR）对冠心病患者临床预后意义。方法 回顾性入选CAF研究队列中2013年8月至2020年12月在北京大学第一医院完成冠状动脉CT血管造影检查后行PCI的冠心病患者729例。采集患者人群基线信息，测量post-PCI caFFR，并采集随访信息。以主要不良心血管事件（MACE，包括心原性死亡、非致死性心肌梗死和缺血驱动的血运重建）为主要研究终点。次要研究终点为全因死亡、任何原因的血运重建。通过时间依赖的受试者工作特征（ROC）曲线计算预测MACE风险最佳postPCI caFFR值，根据该值进行分组。绘制不同组别MACE的Kaplan-Meier曲线。使用Cox比例风险模型分析post-PCI caFFR与临床各结局指标的关系。结果 729例患者中，男性517例（70.92%），平均年龄（64.40±10.31）岁。平均随访（4.29±2.11）年中，共14例（1.92%）患者失访。ROC曲线分析显示postPCI caFFR最佳界值为0.86,424例患者post-PCI caFFR>0.86。Post-PCI caFFR>0.86的患者发生MACE风险显著低于post-PCI caFFR≤0.86的患者（7.00%比14.62%,P=0.001），其中缺血驱动的血运重建风险降低为主要驱动因素（6.52%比11.63%,P=0.017）。此外，post-PCI caFFR>0.86的患者发生任何原因的血运重建的风险也显著低于post-PCI caFFR≤0.86的患者（13.53%比19.60%,P=0.029）。通过Cox比例风险模型post-PCI caFFR≤0.86对临床结局的影响进行单因素和多因素回归分析，结果提示postPCI caFFR≤0.86是临床结局的独立影响因素。经多因素调整后post-PCI caFFR≤0.86的患者MACE发生风险升高1.33倍（HR 2.33,95%CI 1.44～3.77,P=0.001），非致死性心肌梗死的发生风险升高2.06倍（HR 3.06,95%CI 1.06～8.80,P=0.038），任何原因的血运重建的发生风险升高0.54倍（HR 1.54,95%CI 1.06～2.24,P=0.023）。结论 post-PCI caFFR≤0.86的患者MACE风险显著增加，主要由缺血驱动的血运重建导致，提示post-PCI caFFR对预后的预测价值。

关键词(KeyWords)： 冠心病;经皮冠状动脉介入治疗;主要不良心血管事件;血流储备分数;预后

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划项目（2021YFA1000204,2021YFA1000200）

作者(Author): 文新艳,方舒,杨帆,范芳芳,周佐邑,郑博,龚艳君,霍勇

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